Child sexual abuse is an outrage perpetuated against unsuspecting young children and it has spread its tentacles to all strata of society all over the world-India included. Given the nature of the crime and the vulnerability of the victims, namely children, the issue mostly remains hidden in dark and hidden recesses of a complacent society. Acknowledging the existence of Child Sexual Abuse is the first step towards addressing this serious health concern in any civilized society.

Medindia spoke to Tulir, a registered non-profit Trust based in Chennai, South India, that has been working against child sexual abuse in India since 2004. The Centre for Prevention & Healing of Child Sexual Abuse (CPHCSA) is the inspiration of Vidya Reddy, Founder Director, Tulir,who saw the high prevalence of child sexual abuse while volunteering for a child helpline in Chennai and decided to start an organization exclusively to highlight and address this serious issue in India. Alankar, Vipin and Nancy have joined hands with her in the crusade against a malady that is desperately crying out for attention in India.

Tulir (http://www.tulir.org/) has won several national and International awards and works with many organizations such as Intervention Society for the Prevention of Child Abuse, Chicago, and Terres Des Hommes working across Europe to establish the rights of children.

Q. How prevalent is child sexual abuse in India?

A. India being largely a conservative society, we have hitherto brushed this serious problem under the carpet and pretended it was never there in the first place. Our children continue to be abused by close relatives, neighbors, servants, drivers, rikshawalas who take them to school, care givers and a host of other people any child would readily and innocently trust.

When the abuser is a close family member, the child's parents try to protect the abuser to preserve the 'family honor' from public glare and so disregard the child's complaints of abuse. Frantic attempts are made to pacify/threaten/silence the abused child and eventually the child ends up feeling confused and guilty, mistakenly blaming itself for ruining the family's peace.

In recent years, with constant awareness campaigns, media support, child helpline services and support from the government, India is moving towards a professional approach to this issue of child sexual abuse and restoring the physical and mental health of abused children.

Q. Can you share with our readers some of the obstacles you encounter in identifying and addressing child sexual abuse cases in India?

A. 'Sex' is still taboo in many areas in India and elders who recognize an abuse under their roof take matters into their hand and try to hush it up. In the West, education on Personal Safety and Sexuality is mandatory in schools from the Primary classes onwards. In India, neither parents nor schools are ready to impart sex education to children and the child is generally unprepared when the abuse happens for the first time.

When the abuser is a close family member the child is hurt and confused. Most often, the child only wants the abuse to stop, and does not hate the relative. A 10-year-old mentally challenged girl was entrusted into the care of her grandparents because her parents had split and the mother was working in an office. The grandfather took good care of the girl, sent her to school and the child lovingly trusted the grandfather. When the grandfather began sexually abusing the girl, she was bewildered. When Tulir was alerted to the abuse, the child told us she still loved her grandfather—she only wanted him to stop "doing things to her and hurting her."

If intervention is not prompt and appropriate, the resulting trauma is worse than the primary abuse. Lack of awareness at all levels compounds the misery of the abused child soon after a case of sexual abuse is noticed. In 2005, a 5-year-old child was lured by a stranger and raped in a secluded spot on her way back from school. The child walked home bleeding and the parents took her to the local clinic. She was given First Aid at the clinic, sent to a police station and shunted between 3 different hospitals that sent her away because the doctors were unsure as to how to deal with the case. Finally a senior doctor arranged for the child to be sent in an ambulance to the fourth hospital. When the child was finally drifting to sleep at 1 am in the morning, the police (who most often choose to go by the book in such cases) arrived at the hospital waking up the child for enquiry into the charge!

Ideally, child sexual abuse cases have to be dealt with a multi faceted, multidisciplinary team consisting of social workers, physicians, psychiatrists, police and lawyers. It is difficult to get this kind of co ordination in India and the abused child is often sidelined when things are managed in an unprofessional manner.

Most offenders are let loose because identifying child sexual abuse is difficult in many cases. It doesn't always manifest as physical injuries when the child is fondled or forced into oral sex or used in various ways for sexual gratification. Delhi police have set the precedent by supplying readily available kits to guide the police in dealing with child abuse cases.

Recently doctors from the Royal College of Pediatrics and Child Health from UK, and professionals from Australia and Sri Lanka, visited Chennai with a multidisciplinary team of police, lawyers, medical experts and social workers to demonstrate how typical cases of child abuse should be handled without traumatizing the abused child. Professor Harendra de Silva, a pioneer in the identification of child abuse in Sri Lanka accompanied the Tulir team to train medical professionals in government hospitals all over Tamil Nadu on how to deal with child abuse cases.

There is a greater awareness now, but we still have a very long way to go.

Q. Tell us some of Tulir's initiatives to address the issue of child abuse in India?

A. We undertake research and documentation programs to highlight and educate the public about the prevalence of child abuse in India and to evolve prevention strategies in the Indian context. A research project that Tulir undertook in 2005, on "Prevalence and dynamics of child sexual abuse among school-going children in Chennai" provided a shocking revelation. Out of a sample of 2,211 child participants in the survey, 939 or 42 per cent had undergone some form of child abuse.

We have evolved a school based curriculum on Personal Safety Education to empower children participate in their own protection. We frequently visit schools and conduct orientation programs for parents, intensive workshops for teachers and most importantly meet children and encourage them to speak out if they are subjected to an "unwarranted touch."

Healing and Intervention is done by adopting a multi disciplinary approach towards a holistic healing of abused children referred to us and we have a Training and Consultancy program wherein we regularly share our knowledge through sensitizing and skill building programs for Teachers, Social Workers, Doctors, Law enforcers, Parents and other organizations working on related issues.

Public awareness of this issue and children's awareness of their rights have to be stepped up to a great extent. Only then more sexual abuse cases will be reported and appropriate intervention and help can reach the victims. We publish booklets, posters, training guides and multimedia resources on child sexual abuse, use different platforms to sensitize the public consciousness and network with individuals, groups and organizations, and professional sectors, such as law enforcement, judiciary, health care and education to promote this cause that is crying out for immediate attention.

Q. Apart from creating a greater awareness on this issue through our Health network, how can Medindia participate in your fight against child sexual abuse?

A. Many medical professionals are grossly ignorant about the prevalence of child sexual abuse in India and hence are ill-equipped to deal with cases of child sexual abuse referred to them. Some do not give a medical report on time for the police to prepare a charge sheet against the offender. Some give a vague, but damaging report, such as "Rape not seen."

Worse still some doctors who don't even know (or pretend not to know that child sexual abuse exists in India) treat a child for sexual disease and fail to probe how the child contracted the disease.

Many doctors associate only physical injuries, body pain or urinary tract infection with sexual abuse in a child. They are ill equipped to look beyond the post traumatic distress in the child and recognize the harm perpetrated on its wellbeing. Hence very rarely do doctors identify sexual abuse when an ailing child is brought to them by parents. A 12-year-old girl frequently complained of chest pain and was brought to the doctor and it turned out that the girl was being routinely abused by a close relative and she was trying to make it known to elders. Doctors should make the effort to learn more about identifying child sexual abuse and make immediate referrals to specialists in order to facilitate a holistic healing for the abused child— healing in body, mind and spirit.

Medindia can bring about a greater awareness among medical professionals on this issue so that they stop treating an abused child patient as yet another "case."

Child sexual abuse needs to be addressed seriously because its effects are enormous, harming the wellbeing of individuals and society in the long run. Abused children have poor health, they neglect schoolwork, grow up becoming depressed and even suicidal and sometimes turn violent and abusers themselves as they grow older. But with appropriate help and intervention along with family and community support it is quite possible for the victims to shake off the ill effects of abuse and move on in life. We at Medindia are committed in creating greater awareness among professionals, parents and the general public so that child sexual abuse will soon be widely recognized as a social and health problem and given due attention. An online support group for this purpose can be established, if the right activist can moderate the group. We want you to write to us and help us help our children.

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